Post-COVID-19 syndrome in outpatients: a cohort study

Desgranges, Florian; Tadini, Eliana; Munting, Aline; Regina, Jean; Filippidis, Paraskevas; Viala, Benjamin; Karachalias, Eleftherios; Suttels, Véronique; Haefliger, David; Kampouri, Eleftheria; Singer, Mathias Van; Tschopp, Jonathan; Stettler, Laurence Rochat; Schaad, Siméon; Brahier, Thomas; Chabloz, Yolanda Mueller; Gouveia, Alexandre; Opota, Onya; Carron, Pierre‐Nicolas; Guéry, B.; Papadimitriou‐Olivgeris, Matthaios; Boillat‐Blanco, Noémie

doi:10.1101/2021.04.19.21255742

Cited by 12 publications

(22 citation statements)

References 41 publications

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“…The remaining estimates for non-hospitalized adults come from studies with control groups, however without population-based samples. Three studies included only non-hospitalized participants, reporting estimates of 7.5% [ 18 ], 12% [ 19 ], and 16% [ 20 ]. Some of their limitations include 1) small sample sizes, 2) the use of serology testing, not allowing for an accurate identification of infection start and 3) recall bias.…”

Section: Resultsmentioning

confidence: 99%

Long COVID Through a Public Health Lens: An Umbrella Review

Nittas¹,

Gao²,

West³

et al. 2022

Public Health Rev

142

111

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Objectives: To synthesize existing evidence on prevalence as well as clinical and socio-economic aspects of Long COVID.Methods: An umbrella review of reviews and a targeted evidence synthesis of their primary studies, including searches in four electronic databases, reference lists of included reviews, as well as related article lists of relevant publications.Results: Synthesis included 23 reviews and 102 primary studies. Prevalence estimates ranged from 7.5% to 41% in non-hospitalized adults, 2.3%–53% in mixed adult samples, 37.6% in hospitalized adults, and 2%–3.5% in primarily non-hospitalized children. Preliminary evidence suggests that female sex, age, comorbidities, the severity of acute disease, and obesity are associated with Long COVID. Almost 50% of primary studies reported some degree of Long COVID-related social and family-life impairment, long absence periods off work, adjusted workloads, and loss of employment.Conclusion: Long COVID will likely have a substantial public health impact. Current evidence is still heterogeneous and incomplete. To fully understand Long COVID, well-designed prospective studies with representative samples will be essential.

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Section: Resultsmentioning

confidence: 99%

Long COVID Through a Public Health Lens: An Umbrella Review

Nittas¹,

Gao²,

West³

et al. 2022

Public Health Rev

142

111

View full text Add to dashboard Cite

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“…21 Similar to our findings, several literature reviews found that fatigue, respiratory symptoms, cognitive and mental health issues were most frequently reported. 3,20,[22][23][24] Memory impairment, brain fog, poor attention or difficulty thinking have been reported by other authors in 22-88% of patients with lasting symptoms, 4,23,25,26 but these prevalences did not take into consideration the contribution of mood disorders or fatigue. These two factors were highly associated with cognitive abnormalities in our study and in other studies.…”

Section: Discussionmentioning

confidence: 94%

“…As reported elsewhere, our hospitalized cases had a higher prevalence and severity of PCC than ambulatory cases, 12,14,20 with female sex and increasing age also associated with higher PCC risk. 9,12,15,16,25,[32][33][34] We could not properly assess the impact of vaccination as few of our participants had been vaccinated at the time of their COVID-19. Lasting post-COVID-19 symptoms disrupt work life with 8% to 73% indicating they were unable to return to previous full-time work 3 to 8 months after acute COVID-19 4,11,35 .…”

Section: Discussionmentioning

confidence: 99%

“…3,15 We did not collect information on some potentially relevant risk factors, such as comorbidity or initial COVID-19 symptoms and their severity. 14,15,25,32,34 Our questionnaire, designed in the fall 2020, did not collect data on insomnia or post-exertional malaise later also considered to be PCC-qualifying symptoms. 21 In conclusion, PCC may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition.…”

Section: Discussionmentioning

confidence: 99%

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Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada

Carazo

Skowronski

Laforce

et al. 2022

Preprint

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Importance. Most adults with COVID-19 do not require hospitalization, but the subsequent risk of post-COVID condition, including associated psychological and cognitive dysfunction, remains poorly understood among non-hospitalized versus hospitalized cases. Objective. To assess the prevalence and duration of post-COVID condition, including physical, psychological and cognitive symptoms. Design. Case series and case-control study between December 2020 and May 2021 Setting. Healthcare workers in Quebec, Canada Participants. Eligible cases were symptomatic healthcare workers with PCR-confirmed COVID-19 between July 2020 and May 2021. Among 17,717 contacted cases, 6061 (34%) participated. A random sample of symptomatic healthcare workers with negative PCR result between November 2020 and May 2021 served as controls. Among 11,498 contacted controls, 4390 (38%) participated. Exposures. In multivariable models, sociodemographic and clinical characteristics, as well as vaccine history, were evaluated as potential risk factors. Prevalence ratios compared self-reported cognitive dysfunctions (difficulty concentrating; difficulty organizing oneself; forgetfulness; loss of necessary items) among cases with post-COVID condition to controls, adjusting for psychological distress and fatigue. Outcomes. Post-COVID condition was defined by symptoms persisting ≥4 weeks or ≥12 weeks after COVID-19 onset. Results. Four-week and 12-week post-COVID condition prevalences of 46% (2,746/5,943) and 40% (653/1,746), respectively, were observed among non-hospitalized cases and 76% (90/118) and 68% (27/37), respectively, among hospitalized cases. Hospitalization, female sex and age were associated with higher risk. A substantial proportion of non-hospitalized cases with 4-week post-COVID condition often or very often reported cognitive dysfunction, including concentration (33%) or organizing (23%) difficulties, forgetfulness (20%) and loss of necessary items (10%), with no decline at 12 weeks. All four aspects of cognitive dysfunction were 2.2 to 3.0 times more prevalent among cases with post-COVID condition than in controls, but also independently associated with psychological distress and fatigue. Conclusions and relevance. Post-COVID condition may be a frequent sequela of ambulatory COVID-19 in working-age adults, with important effects on cognition. With so many healthcare workers infected since the beginning of the COVID-19 pandemic, the ongoing implications for quality healthcare delivery could be profound should cognitive dysfunction and other severe post-COVID symptoms persist in a professionally-disabling way over the longer term.

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“…PACS has been mainly reported after hospitalization[3,4], and may be linked to post-intensive care syndrome and post-traumatic stress disorders. Few studies have addressed the persistence of symptoms after mild disease[5–7]; six months after the onset of COVID-19, approximately one-third of these patients remain symptomatic. Moreover, most reports on the effect of PACS on patients’ quality of life focus on European and North American regions [7].…”

Section: Introductionmentioning

confidence: 99%

Post-Acute COVID Syndrome, the Aftermath of Mild to Severe COVID-19 in Brazilian Patients

Barreto

Duarte

Cerqueira‐Silva

et al. 2021

Preprint

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Objective: To describe persistent symptoms after acute COVID-19 in different spectrum of disease severity in a population from an upper/middle income country, and identify the main clinical features impacting the quality of life. Design: Cross-sectional study. Setting: Outpatient clinic from a public post-COVID-19 health center (CPC) at Bahia-Brazil, a state where 80% are black or mixed race. Participants: Patients admitted between August 2020 and February 2021 with symptoms at least one month after the onset of COVID-19. Main outcome measures: PACS and related disorders such as hospitalization one month or later after disease onset, biochemical dysregulation and reduced quality of life (EQ-5D-5L questionnaire). Results: Among 683 individuals assisted at CPC in this period, 602 were recruited. Patients had average of 52 (±14.6) years, 355 (59%) were female, 528 (88%) black/brown. Individuals were classified as mild (39.9%), moderate (27.9%) or severe (32.2%) during acute illness if outpatient, hospitalized non-UCI or UCI, respectively. Most patients reported a polysymptomatic profile, in median eight (IQR=6-9) acute symptoms. The most frequent residual symptoms were dyspnea (66%), fatigue (62%) and chest pain (43%). Women were more affected regardless disease severity at acute stage: presented more residual symptoms [4 (2-6) vs 3 (2-4)] and a higher impact in quality of life. Altered HbA1c [(184/275 (66.9%)], high CRP levels [195/484 (40.3%)] and anemia [143/545 (26.2%)] were the most common abnormalities in laboratory exams. 76 patients presented HbA1c above 6.4% although only 42 referred previous diagnosis of diabetes mellitus. After one month of disease onset, 30 patients required hospitalization, including seven cases with mild acute illness. Hospital admission after acute disease was required on 30 patients, seven (23%) were mild. Quality of life had been affected for 357/404 (88.4%) patients according to EuroQoL (EQ-5D-5L), mainly the domains of anxiety/depression [severe or extreme anxiety for 79/401 (19.7%)] and pain/discomfort [severe or extreme pain for 71/403 (17.6%)]. The median EuroQoL Global Score was 70 [IQR 50-80]. PACS symptoms such as dyspnea, chest pain, and fatigue, was associated with decreased quality of life. Conclusions: PACS, such as dyspnea, chest pain and fatigue, occurred after variable degree of disease severity. Among this majority black/mixed-race patients, woman seemed to be more affected. Other consequences included post-acute hospitalization, and abnormal glucose metabolism and reduced quality of life.

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Post-COVID-19 syndrome in outpatients: a cohort study

Cited by 12 publications

References 41 publications

Long COVID Through a Public Health Lens: An Umbrella Review

Long COVID Through a Public Health Lens: An Umbrella Review

Physical, psychological and cognitive profile of post-COVID condition in healthcare workers, Quebec, Canada

Post-Acute COVID Syndrome, the Aftermath of Mild to Severe COVID-19 in Brazilian Patients

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